Them sneaky, creepy lows…
I have always been told that it becomes more difficult to recognize lows the more years that you have diabetes. It’s common for veterans of this disease to develop hypoglycemia unawareness as the years go on. And I’ve also been told this issue is exacerbated the more frequently you have lows. But it’s one thing to be told this will happen, and another thing to have it actually start happening to you.
Thursday morning I was out seeing customers. I had corrected a high-ish fasting of 160mg/dL with two units of insulin, also covering the small amount of carbs in my breakfast. I walked out of the office I’d been visiting and hopped in my car, and opened my computer to start logging the visit. I felt so exhausted, even though I was on my second cup of coffee. I felt like I could just….fall asleep right there. Man this is going to be a long day I thought to myself. If I’m this tired right now, imagine how I’ll feel at three o’clock. I kept plunking away at the computer though, entering the information from the customer visit. Then, that little diabetes voice in my head, the one that knows when something just isn’t right, and you’re more than just tired, spoke up. I set the computer down and picked up my kit. I lanced my finger and placed the blood drop on the strip. And then 50mg/dL appeared on the screen.
There was a time when 50 caused me to sweat, shake, rattle, and roll. But this one? I just felt tired. I shuddered to think what could have happened if I had decided to drive to my next appointment right away instead of logging the info in my computer. I didn’t have the slightest hint of a low - none of my usual symptoms anyways. And I was all the way down at 50. 50 is low. 50 is one number away from the 40s which is REALLY low. And I don’t like the fact that I didn’t have the foggiest idea it was there.
I’m going on almost 20 years of living with Type 1. I don’t know how many lows I’ve had in this lifetime, but I’m sure it’s in the thousands at this point. I do know that every low I have can make the next one harder to detect, and that for every year that rolls by, hypo unawareness can increase. And I also know that it’s definitely starting to happen. This is the part about having diabetes that drives me crazy - the feeling that you’re losing control of this disease, depsite your best efforts. The thought that hypo unawareness could put me at risk while working, while biking, while sleeping - any time in my normal day to day life just sucks. This is a part of diabetes that makes me crazy, and crazy mad at how unfair it is.
But then I have to stop the pity party and realize I have some powerful tools to fight this. First and foremost, I am lucky enough to have a continuous glucose monitor. It didn’t beep at me on Thursday because I’d left the receiver in the car while I went to make my sales call - which there’s simply no excuse for. You have a monitor, covered by your insurance, take the damn thing EVERYWHERE you go. It’s not that hard. If I’d had the receiver on me, I might have caught that low before I got down to 50. Technology is only helpful if you actually use it.
That said, I’m curious to know if any of your readers out there have 1) experienced increasing hypo unawareness as the years go on and 2) have any strategies to combat it - either in the moment or to prevent it from getting worse. For example has anyone started to try and run their numbers a wee bit higher to prevent more lows? Or anything else? Leave a comment and let me know!
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Comments
Yes, it’s all true. I woke up the other night with a 46, which is unusual for me. Usually it’s in the 60s anyway, so I was really surprised. I keep cranberry juice by my bedside so all was soon fine. But it’s really scary and makes for uncomfortable doctor conversations.
Deven I totally agree - it’s those thing slike the 46 that seem to come out of nowhere that drive me up the wall - and yes they make for really uncomfortable conversations with the doctor - I hate to see that look on his face:(
Within 5 years of starting on insulin, hypoglycemia unawareness can start developing, even in people who don’t have autonomic neuropathy. I noticed it happening in me when Lantus came out and I switched over from NPH. I was so much happier with Lantus overall, but did notice I didn’t feel my lows as much. I’ve had an autonomic neuropathy diagnosis for a few years now and do get quite a bit of undetected hypos. One thing I’ve had to do is discover different clues that signal my lows. If I’m going to bed and I can’t seem to fall asleep, it could be a low. When I can’t remember what I ate 5 minutes ago, or what I came into the room for, or even my own name… it must be a low! I test every time I get behind the wheel of a car. I test as soon as I get up in the morning to make sure I’m not too low to get in the shower. Thank god the Dexcom works for me and I finally got insurance to cover it because that has saved me many times, and it allows me to keep trying for tighter control than if I didn’t have a CGM. I had 4 lows today after leaving my pump download on my endo’s desk… She’s probably going to tell me to cool it so my brain can reset my hypo threshold…
Though you have years on me in length of dealing with this disease, I’ve had plenty of hypoglycemic unawareness. I don’t have a CGM, so my only recourse is to test when I feel weird. But I don’t test BEFORE I feel bad, which leads to situations where my BG is 27, 28, 30. I now keep my diamurse (diabetic man purse) with me at all times, so I have quick access to some hard candy. I don’t have a strategy for combating lows except I will sometimes cut back my insulin dose if I’m going to be very active. I’m still trying to figure it out myself.